NPIMap

Individual provider Active NPI

Joan M Bloom, M.D.

  • Family Medicine Physician
  • Ponderay, ID
National Provider Identifier
1033229307
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M8563 Issued in ID
Practice address
30544 Highway 200
Suite 102
Ponderay, ID 83852
Phone
(208) 265-9817
NPI assigned
Aug 30, 2006
Last updated
May 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X M-8563 ID
Family Medicine Physician 207Q00000X M8563 ID Primary

Addresses

Primary practice location

30544 Highway 200
Suite 102
Ponderay, ID 83852

Mailing address

30544 Highway 200, Suite 102
Ponderay, ID 83852
Phone (208) 265-9817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040106000582 ID Practitioner - Family Practice 6305745621 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michael R Dibenedetto MD PLLCGroup PAC ID 0840385670, 8 clinicians

Practice addresses (Care Compare)

30544 Hwy 200
Suite 102
Ponderay, ID 83852-5005
Phone (208) 265-9817

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
26.1 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
87.01

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions18
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M8563IDMDFamily Medicine Physician
M-8563IDMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michael R Dibenedetto MD PLLC CurrentSince Jul 1, 2011 Accepting new patients

Locations

30544 Highway 200
Ste 101
Ponderay, ID 83852
Phone (208) 263-6300

30544 Highway 200
Ste 102
Ponderay, ID 83852
Phone (208) 263-6300

30544 Highway 200
Ste 103
Ponderay, ID 83852
Phone (208) 946-5110

Interoperability endpoints

  • Direct secure messaging: joan.bloom@nioasm-id.direct.office.nextgen.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1033229307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200, SUITE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "83852",
            "telephone_number": "208-265-9817",
            "fax_number": "208-664-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200",
            "address_2": "SUITE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "83852",
            "telephone_number": "208-265-9817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "JOAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ID",
            "license": "M-8563",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M8563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponderay, ID

Sources for this page

Verify at the official NPI Registry.